Libby MT is an underserved frontier community where vermiculite ore was mined and processed from the 1920s until 1990. This ore was distributed to 245 sites throughout the U.S. and tens of thousands of households used the end-product for insulation and horticulture activities. The Libby vermiculite, referred to as Libby Amphibole (LA), contains asbestos minerals and exposure is associated with pulmonary function loss, pleural and interstitial lung diseases and respiratory mortality. A federal investigation clearly demonstrated that children growing up in Libby as well as all 28 other sites thus far investigated, had numerous pathways of exposure. These pathways included ambient air pollution as well as contamination of homes, schools, playgrounds and manufacturing dump sites near residential areas. LA is attractive to children because of its silver sparkles and ability to pop when heated. Pleural plaques were retrospectively identified in a child as young as nine. Almost no information is available, however, on the children who grew up Libby and other contaminated communities who had on-going childhood environmental exposures. Concern about childhood exposures is amplified by understanding that at birth, infants have completed only 20% of alveolar lung development and have immature clearance mechanisms. As lung growth and development continues until early adulthood, children are likely the most vulnerable group. The Libby community and numerous other contaminated towns are very concerned about their children's health. The Center for Asbestos Related Disease (CARD) has been a medical and educational community based organization serving Libby since 2000 when federal investigations began. CARD is a partner on this study. The three study aims are 1) determine if childhood exposure to LA is associated with a significant increase in adverse pulmonary effects, 2) develop and utilize a comprehensive environmental exposure matrix to characterize childhood exposures and 3) develop, implement and evaluate a well-defined reciprocal outreach and communication program. The Libby young adults have now had a sufficient latency period where effects on their lung development can be measured and actions to prevent or decrease morbidity taken. The impact of this study far exceeds the boundary of Libby, as many other communities also have been contaminated. Further, this study represents one of the clearest examples of widespread contamination resulting in chronic exposure and likely direct adverse impact on the developing lungs of children. PUBLIC HEALTH RELEVANCE: Libby MT is one of many communities with widespread contamination due to mining and milling operations of vermiculite containing asbestos minerals. Children of Libby have had documented chronic exposure due to contamination of their homes, schools and playgrounds. They are a particularly vulnerable population as their lungs are immature at birth and continue to develop until adulthood. This project will work in concert with the Center for Asbestos Related Disease in the Libby community to better understand the health effects on children in that and other contaminated communities.